Comparison of Subxiphoid and Intercostal Uniportal Video‐Assisted Thoracoscopic Surgery for Early Thymoma, Lung Cancer, and Pneumothorax: A Retrospective Single‐Center Study

ABSTRACT Background Video‐assisted thoracoscopic surgery (VATS) is a minimally invasive technique for early thymoma, early‐stage non‐small cell lung cancer (NSCLC), and primary spontaneous pneumothorax (PSP). The subxiphoid uniportal VATS (SU‐VATS) approach offers potential advantages over the intercostal uniportal VATS (IU‐VATS) by reducing nerve injury and postoperative pain. Methods A single‐center retrospective study at The Fifth Hospital of Ganzhou included 756 patients who underwent SU‐VATS or IU‐VATS between January 2018 and September 2024. The propensity score matching (1:1) resulted in two cohorts of 192 patients each. Primary outcomes were inflammatory markers (Hs‐CRP and WBCs) on postoperative day 1 (POD1) and visual analog scale (VAS) pain scores on POD1, POD3, POD7, and POD30. Secondary outcomes included operative time, blood loss, drainage duration, hospital stay, and complications. Results SU‐VATS significantly reduced Hs‐CRP (5.35 vs. 9.65 mg/L, p < 0.001) and WBCs (6.48 vs. 10.67 × 10 9 /L, p = 0.004) on POD1. VAS scores were lower in SU‐VATS on POD1 (1.48 vs. 3.21, p < 0.001), POD3 (1.19 vs. 2.73, p < 0.001), and POD7 (1.07 vs. 1.86, p < 0.001), with no difference by POD30 (0.32 vs. 0.36, p = 0.160). Operative time, blood loss, drainage duration, hospital stay, and complication rates were similar between groups. Conclusions SU‐VATS reduces early postoperative inflammation and pain without compromising operative efficiency or safety compared to IU‐VATS. These findings support adopting the subxiphoid approach as a preferred minimally invasive technique in thoracic surgery.